Screening should be selective

EDITOR —The editorial on screening for hydroxychloroquine retinopathy covered none of the recent publications on the subject and failed to distinguish those cases in which screening is necessary.1

Levy et al's review of 1505 patients found no cases of proved retinopathy in patients taking <6.5 mg/kg/day of hydroxychloroquine but one case in a patient taking a higher dose.2 Silman and Shipley point out that “bull's eye retinopathy” can occur in patients not taking hydroxychloroquine.3 Indeed, Scherbel et al reported that the incidence of maculopathy in patients with rheumatoid arthritis was greater in untreated patients than in those receiving hydroxychloroquine or chloroquine.4 …